Neurology & Pain Management Coding Alert

Here’s the latest news on implementation, straight from the AMA.

January 2013 brings coding changes for every specialty, particularly if your providers offer chemodenervation injections or neuromuscular electrodiagnostic studies. Read on for highlights experts shared at the American Medical Association’s (AMA) annual CPT® and RBRVS Symposium in Chicago in November.

Prepare for Big Chemodenervation Changes

If your providers use chemodenervation as a treatment for focal muscle spasticity or chronic migraines, don’t miss important changes to guidelines and code descriptors.

Chemodenervation guidelines for 2013 are revised to state:

• Do not report a destruction code when therapies are not destructive to the target nerve.
• Chemodenervation agent reported separately with chemodenervation codes.

Two chemodenervation codes are revised for next year, and a new option is added to the mix:

• 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve, unilateral [e.g., for blepharospasm, hemifacial spasm]) is now clearly identified as a unilateral code. For bilateral procedures, append modifier 50 (Bilateral procedure).
• 64614 (… extremity and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]) removes the "s" from "extremity." A new coding note directs you to report 64614 only once per session.
• 64615 (… muscle[s] innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral [e.g., for chronic migraine]) is new for 2013. You should report 64615 only once per session, and cannot report it in conjunction with 64612, 64613, or 64614.

"There’s going to be gnashing of teeth over the new chemodenervation codes," presenter Gregory L. Barkley, M.D., predicted when referring to new code 64615. "Providers have been used to reporting multiple codes of 64612 and 64613 when they treat different nerves during an encounter, but the new code changes that. Providers will take a big hit for that."

Plus: Although the descriptor didn’t change, CPT® adds new parenthetical notes to 64613 (… neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]). You can now only report 64613 once per session, and should not report the code with modifier 50 (Bilateral procedure).

Watch Study Counts for Updated NCS Codes

Barkley also advised attendees to be careful when reporting nerve conduction tests in 2013.

"The codes have been restructured to reflect the total number of nerve conduction studies performed as the unit of service, rather than each nerve," he explained. "This will be very important when we report these codes moving forward."

Changes: Familiar test codes 95900-95904 were deleted from CPT® 2013 in favor of seven new options. Codes 95907-95913 (Nerve conduction studies …) each specify the number of studies represented by the code, from one to 13 or more.

"Remember each type of nerve conduction study is counted only once when multiple sites on the same nerve are tested," Berkley added. In addition, a single nerve conduction study includes all orthodromic and antidromic testing. Once you move to a different muscle or nerve or nerve branch, the diagnostic testing would be considered a separate nerve conduction study that can be counted.

Also: Two new codes for intraoperative neurophysiology monitoring are introduced in 2013. The new choices are:

• +95940 -- Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure)
• +95941 -- Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour (List separately in addition to code for primary procedure).

The additions replace deleted code +95920 (Intraoperative neurophysiology testing, per hour [List separately in addition to code for primary procedure]). "There are two divergent styles of approach to performing intraoperative monitoring," Barkley explained. "The physician can either be in the OR in personal attendance during monitoring, or can monitor one or more case outside the OR by staying in communication with the OR team. Replacing +95920 with the new codes allows for differences in circumstances."

Make the Shift to Inclusive Provider Terminology

The most widespread changes throughout CPT® 2013 -- the switch to more inclusive or provider-neutral language -- shouldn’t be difficult for physicians or other providers to put into place.

"The concepts are pretty straightforward," said Richard Duszak, Jr., M.D., an AMA CPT® Editorial Panel member and practicing radiologist. "There’s been an evolution in CPT® for how codes report services by non-physicians."

Result: Hundreds of codes were revised for 2013 to include "provider neutral language." Codes throughout the book have replaced designations of "physician" with "individual" or "qualified health care professional."

Example: The descriptor for 62370 (Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion [includes evaluation of reservoir status, alarm status, drug prescription status]; with reprogramming and refill [requiring skill of a physician or other qualified health care professional]) no longer specifies that the service must be provided by a physician. Instead, the descriptor added "or other qualified health care professional" to what previously noted only "physician."

Exception: A few codes retained the "physician" language, such as those related to skilled nursing facility admissions, because regulations require that a physician admit the patient.

"CPT® is not the turf police," Duszak said. "We’re focusing on the services provided and recognize that sometimes professionals other than physicians are qualified to provide some services. As a nationally recognized reporting system, it’s important for CPT® to maintain provider neutrality."

Continue Enjoying ERX Incentives

The combination of electronic prescribing incentive payments and adjustments will remain in place through 2014. Eligible providers who successfully participate in the program will receive 0.5 percent incentive pay in 2013.

"It’s not much," Kathy Bryant, deputy director of the department of physician services at CMS, acknowledged, "but it’s better than the 1.5 percent reduction adjustment for not successfully participating."